This study was undertaken to evaluate bone response in metastatic prostate cancer patients treated with Enzalutamide with or without Zoledronic Acid in combination with luteinizing hormone-releasing hormone (LHRH) analogue with the use of Whole Boby (WB) DW-MRI.
Most men with fatal prostate cancer develop bone metastases and bone is often the dominant or the only site of metastatic disease. Bone metastases are an important cause of morbidity since they are associated with skeletal related events (SREs) including pathologic fractures, spinal cord compression, and need for surgery or radiation therapy to bone. Osteoclast-mediated bone destruction is the key pathologic mechanism for SREs in prostate cancer and other malignancies. Zoledronic acid (ZA) is a potent inhibitors of osteoclast-mediated bone resorption. ZA has demonstrated to be effective in preventing SREs in patients with castrate resistant disease; however, its efficacy in hormone naïve disease is uncertain. In the last few years new drugs targeting directly the androgen receptor such as Enzalutamide have shown to be very effective in terms of survival prolongation in the management of castration resistant disease and the efficacy in hormone naïve patients is currently under investigation. Interestingly, the results of a large scale, prospective, randomized clinical trial have shown that Enzalutamide administration is also associated with a reduction in the risk of SREs and this raises the question of the usefulness of the addition of bone resorption inhibitors to Enzalutamide. The evaluation of bone response of antineoplastic therapies has always been difficult in metastatic bone prostate cancer patients due to their osteoblastic nature. Whole body diffusion-weighted (DW) MRI has been recently proposed as new imaging tool for grading treatment response in patients with skeletal metastases from prostate cancer. According to the literature data DW images can allow the identification of bone marrow infiltration and tumor necrosis induced by treatment. In addition, this technique allows to monitor the bone marrow restoration. This, this technique was selected to evaluate bone response in metastatic prostate cancer patients treated with Enzalutamide with or without Zoledronic Acid in combination with LHRH-A. Moreover, since androgen-receptor isoform encoded by splice variant 7 (AR-V7) is an androgens' receptor variant that could have a potential clinical utility as a prognostic factor and predictive marker of therapy response, an ancillary study will be conducted to evaluate ARV7 expression in Circulating Tumor Cells (CTC).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
126
Prostate cancer patients with hormone sensitive metastatic bone disease will be treated with LHRH-A + Enzalutamide in the presence or absence of Zoledronic Acid
Patients from both arms will be treated with LHRH-A + Enzalutamide
Azienda Ospedaliera Spedali Civili di Brescia
Brescia, Italy
Evaluation of change in bone response after 6 and 12 months of treatment compared to baseline
Whole-body Diffusion MRI
Time frame: Exam will be performed at baseline and after 6 and 12 months of treatment
Evaluation of bone repair
CT Scan
Time frame: Screening visit; 12 months of treatment
Changes in bone mineral density after 18 months of treatment compared to baseline
Dual energy x-ray absorptiometry (DEXA Scan)
Time frame: Screening visit; 18 months of treatment
Functional Assessment of Cancer Therapy-Prostate
Functional Assessment of Cancer Therapy-Prostate (FACT- P) Questionnaire will be collected from patients.It consists of 27 core items which assess patient function in four domains: Physical, Social/Family, Emotional, and Functional well-being, which is further supplemented by 12 site specific items to assess for prostate related symptoms. Each item is rated on a 0 to 4 Likert type scale, and then combined to produce subscale scores for each domain, as well as a global Qquality of Life (QoL) score.
Time frame: Monthly until end of treatment (18 months)
Brief Pain Inventory-Short Form Questionnaire
Brief Pain Inventory-Short Form (BPI-SF) Questionnaire will be collected from patients.In particular, a 0-10 numerical rating scale was used to measure pain severity items where 0=no pain and 10=pain as bad as you can imagine or with 0=pain did not interfere with my normal life and 10=pain interferes ompletely. A question about the percentage and duration of pain relief was also included.
Time frame: Monthly until end of treatment (18 months)
Weight evaluation
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Evaluation of patient weight expressed in kg after 18 months of treatment compared to baseline
Time frame: Screening visit; 18 months of treatment
C-terminal telopeptide analysis
C-terminal telopeptide analysis (CTX, ng/ml) evaluation on peripheral blood samples
Time frame: Screening visit; 2, 4, 6, 9, 12, 18 months of treatment
Bone alkaline phosphatase analysis
Bone alkaline phosphatase analysis (U/uL) evaluation on peripheral blood samples
Time frame: Screening visit; 2, 4, 6, 9, 12, 18 months of treatment